Why some state-run health exchanges worked

Two months after they launched, most of the online health insurance exchanges run by states have vastly outperformed their federal counterpart, healthcare.gov.

Four of the states with their own exchanges – Connecticut, Kentucky, Rhode Island and Washington – have sites that have run especially smoothly, becoming models for states such as Arkansas, Idaho, Illinois and New Mexico that are planning to launch their own sites in 2014. Because of ongoing problems with the federal site, other states that are using it might also decide to build their own next year.

Not every state-run exchange has performed well – Hawaii, Oregon, Maryland and Vermont all have had significant problems. However, even though the 14 exchanges run by states and the District of Columbia serve less than a third of the U.S. population, they accounted for more than half of all Medicaid enrollments and 75 percent of private insurance sign-ups in October, according to the federal government’s most recent enrollment report.

It’s too early to pinpoint exactly why some state-run exchanges did better than others, but two common characteristics stand out: simplicity and an abundance of testing.